Basics Of Mobilization

Question 1

What are the steps of objective examination ?

Answer 1

• active range of motion
• passive range of motion
• accessory motions/ tests/ end feel
• special tests

Question 2

Define flexibility

Answer 2

Flexibility refers to a musculotendinous unit’s ability to elongate under a stretching force. The amount of flexibility of a structure is related to its stiffness, suppleness ans pliability.
Prolonged loss of flexibility can reduce ROM.

Question 3

Define range of motion

Answer 3

Range of motion is the amount of mobility of a joint and is determined by the soft-tissue and bony structures in the area. The status of tissues - blood vessels, muscles, tendons, ligaments, skin, subcutaneous tissues, nerves and capsule - all affect a joint’s ROM.

Question 4

Define active range of motion

Answer 4

Is the range of motion that a joint achieves when moved actively by the patient. May also be referred to as active movement tests AMTs.

Question 5

Define passive range of motion

Answer 5

It’s the range of motion of a joint passively moved by the therapist.
Passive ROM can be divided into physiological passive ROM and passive accessory ROM.

Question 6

Define passive physiological range of movement

Answer 6

Passive physiological movements are performed when someone or something moves the segment/limb while the patient is relaxed, through the joint normal ROM.

Question 7

Define the passive accessory range of motion

Answer 7

Is a component of joint movement that contributes to the overall physiological movement.

Question 8

What are the causes of AROM limitation?

Answer 8

• muscle strength
• muscle length
• joint capsule
• ligaments
• pain
• swelling
• motor control/ CNS

Question 9

Should PROM and AROM be the same ?

Answer 9

They should be similar but en PROM with overpressure will likely move the segment further than AROM.

Question 10

What if a patient has greater PROM than AROM ?

Answer 10

Something is likely wrong with their ability to recruit the muscles to perform the movement

Question 11

What if patient has the same AROM and PROM but the amplitude of the movement is under the normal ?

Answer 11

The joint is likely blocked or being stopped by factors other than muscle strength. It could be mechanical or caused by pain.

Question 12

In which situations is the connective tissue associated with loss of AROM/ PROM ?

Answer 12

• patient exposed to long periods of bed rest
• fracture / immobilisation
• CNS pathology
• joint arthroplasty

Question 13

Define connective tissue

Answer 13

Is a broad classification for non contractile tissues which are however playing a moderate role in the transmission of forces and movement.
It is continually replaced and reorganized as part of normal body function.

Question 14

What is the composition of connective tissue ?

Answer 14

• elastin
• reticulin
• ground substance
• fibroblasts

Question 15

What is elastin (connective tissue)

Answer 15

Elastin fibers provide structures with extensibility. These fibers can withstand elongation stress and return to initial length.
Tissues that have more elastin are more extensible.

Question 16

What is reticulin (connective tissue)

Answer 16

Reticulin is essentially composed of collagen type III fibers
They play an important role during post injury repair process

Question 17

What is ground substance (connective tissue) ?

Answer 17

Is a structure less organic gel like substance
It serves to reduce friction between the collagen and elastin fibers
It maintains space between the fibers to prevent excessive cross liking
It transports nutrients to the fibers

Question 18

What are fibroblasts (connective tissue) ?

Answer 18

Fibroblasts are cells that create the connective tissue components

Question 19

Why is collagen crucial for the musculoskeletal system ?

Answer 19

Collagen provides passive structural stability
It provides different tissues with strength and stiffness
Types I, II and III are the most present in the musculoskeletal system

Question 20

What is collagen type I ?

Answer 20

Is very strong, has a high tensile strength, found especially in tendons and ligaments

Question 21

What is collagen type II

Answer 21

Softer than type I, it is found in cartilage and spine

Question 22

What is collagen type III ?

Answer 22

Is elastic, found in the skin, vascular structures

Question 23

What are the effects of immobilization on connective tissue ?

Answer 23

Connective tissue tend to shorten but with daily activities it returns to its normal length.
Immobilization and disuse are sometimes necessary to protect the area and permit the healing process to occur.
The longer a part is immobilized, the more it will affect ROM.
Immobilization contributes to muscle atrophy and bone density loss

Question 24

What are the neurophysiological effects of joint mobilization ?

Answer 24

Pain relief : neuromodulation at CNS level

Small amplitude joint mobilizations, oscillations

Question 25

What are the nutritional effects of joint mobilization ?

Answer 25

Synovial fluid movements

Distraction or small gliding movements

Question 26

What are the mechanical effects of joint mobilization ?

Answer 26

Stretching collagen structures
Loosening adhesions
Inhibitory effects on joints afferent receptors

Question 27

What is descending nociceptive inhibition ?

Answer 27

• comes from the midbrain, mainly periaqueductal grey matter and rostral ventral medulla
• suppresses the release of excitatory transmitters in dorsal horn
• suppresses post synaptic response
• catastrophizing, avoidance and somatisation prevent effective descending inhibition and activate descending facilitation

Question 28

What is capsular pattern ?

Answer 28

If the capsule of the joint is affected there will be a specific pattern in the joint. This pattern could be the resultant of joint reaction with muscle spasm that leads to capsular constriction.
Osteophyte formation could be a possible factor of restriction. Each joint has a specific pattern of limitation. Only the joints controlled by muscles exhibit capsular patterns. Ex : the distal tibiofibular joint and the sacrum do not display any capsular patter.